Graduate Medical Education, 2019-2020
This Appendix presents 2019 National GME Census data detailing the numbers and types of ACGME-accredited training programs and the residents and fellows in them. (Source: JAMA)
Source: JAMA - September 22, 2020 Category: General Medicine Source Type: research

Medical Schools in the United States, 2019-2020
This Appendix presents data from the 2019-2020 Liaison Committee on Medical Education (LCME) annual questionnaire detailing information on the number of students, student demographics, curriculum content, and enrollment at US medical schools. (Source: JAMA)
Source: JAMA - September 22, 2020 Category: General Medicine Source Type: research

The COVID-19 Pandemic and the JAMA Network
Journal editors sit at the crossroads of new ideas and findings, deciding which are worth refining and making public in their journals and which are best saved for another time and place. The global arrival of coronavirus disease 2019 (COVID-19) has brought an increase in manuscript submissions describing and evaluating the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and its morbidity and mortality, distilling what seems like years of science and policy into several months. JAMA Network editors were quickly reeducated in principles of epidemiology and public health related to epidemics ...
Source: JAMA - September 22, 2020 Category: General Medicine Source Type: research

Declines in Lung Cancer Deaths Linked to Treatment Advances
Mortality from non –small cell lung cancer (NSCLC) in the US decreased between 2013 and 2016, a period corresponding with the approval of several targeted therapies for the disease, National Cancer Institute (NCI) researchers recently reported. (Source: JAMA)
Source: JAMA - September 22, 2020 Category: General Medicine Source Type: research

Buprenorphine Implants, Injections Are Underused
Injectable and implantable forms of buprenorphine to treat patients with opioid use disorder (OUD) are less likely to be diverted than oral formulations but they ’re rarely prescribed, according to a recent US Government Accountability Office (GAO) report. (Source: JAMA)
Source: JAMA - September 22, 2020 Category: General Medicine Source Type: research

VA Partners With OnStar to Increase Access to Suicide Prevention Services
OnStar, perhaps best known for providing emergency services for people involved in motor vehicle crashes, recently partnered with the US Department of Veterans Affairs (VA) to improve access to suicide prevention services. (Source: JAMA)
Source: JAMA - September 22, 2020 Category: General Medicine Source Type: research

Audio Highlights
Listen to the JAMA Editor ’s Audio Summary for an overview and discussion of the important articles appearing in this week’s issue of JAMA. (Source: JAMA)
Source: JAMA - September 22, 2020 Category: General Medicine Source Type: research

Safely Recognizing and Responding to Intimate Partner Violence
This JAMA Insights Clinical Update reviews clinical indicators of intimate partner violence (IPV) and ways that clinicians can ask about and begin to assist individuals who experienced IPV in phased, sensitive approaches that do not encourage patients to act before they are ready or compromise their autonomy or safety. (Source: JAMA)
Source: JAMA - September 22, 2020 Category: General Medicine Source Type: research

Life as It Is
In the symposium entitled “Man and Life,” Barzun, writing on “the quality of life,” notes that the term “life” is imprecise and susceptible of varied interpretation. He bases his discussion of its quality principally on the question, “Is life worth living?”—a question that can be answered only personally or , if you will, individually. Nevertheless, he finds signs in our modern industrial-democratic society that the question is being answered in the negative, and he propounds a number of characteristics that have caused deterioration of life’s quality. (Source: JAMA)
Source: JAMA - September 22, 2020 Category: General Medicine Source Type: research

Geographic Distribution of US Cohorts Used to Train Deep Learning Algorithms
This study describes the US geographic distribution of patient cohorts used to train deep learning algorithms in published radiology, ophthalmology, dermatology, pathology, gastroenterology, and cardiology machine learning articles published in 2015-2019. (Source: JAMA)
Source: JAMA - September 22, 2020 Category: General Medicine Source Type: research

CMS Quality Measure Development
To the Editor The study by Dr Wadhera and colleagues stated that the Centers for Medicare& Medicaid Services (CMS) has invested more than $1.3 billion in quality measure development of more than 2300 measures, of which 788 are being used in CMS quality, reporting, and payment programs, and concluded that CMS lacks a strategy to systematically evaluate whether their quality measures improve the delivery of care and health outcomes. Some issues require clarification. (Source: JAMA)
Source: JAMA - September 22, 2020 Category: General Medicine Source Type: research

Physicians and Social Determinants of Health
To the Editor In their Viewpoint, Drs Maani and Galea considered how physicians can most effectively support societal efforts to alleviate adverse social determinants of health to improve the health of individuals in the United States. The authors suggested that physician-level interventions distract from what ultimately must be systemic efforts —a proposition we believe overlooks the profound mitigating effect physicians can have on social determinants of health. (Source: JAMA)
Source: JAMA - September 22, 2020 Category: General Medicine Source Type: research

Physicians and Social Determinants of Health
To the Editor Drs Maani and Galea argued that physicians must engage more heavily in addressing the social determinants of health because these factors significantly drive patients ’ health. The authors focused on 2 major areas: policy action and physician training. Of course, health and health care are different, and the authors made this distinction: “Addressing social determinants in the context of clinical practice devalues and medicalizes the complex burden and barrie rs encountered by those affected by discrimination or poverty.” However, while their argument for engaging physicians in policy soluti...
Source: JAMA - September 22, 2020 Category: General Medicine Source Type: research

Physicians and Social Determinants of Health
To the Editor The perspective offered by Drs Maani and Galea regarding physicians ’ role in social determinants of health highlights the limitations and potential unintended consequences of physicians’ attempts to interface with them. While their conclusion that “[p]hysicians’ most enduring effect may be in changing the conversation around health and responsibility for it ” may prove true, their proposal for how physicians use their voices is more likely to hinder rather than promote efforts to address social determinants of health for 2 reasons. (Source: JAMA)
Source: JAMA - September 22, 2020 Category: General Medicine Source Type: research

CME Quality Measure Development —Reply
In Reply In response to our study, Dr Duseja and colleagues assert that CMS value-based programs, which link quality measures to reimbursement, have led to declines in hospital-acquired conditions, readmissions, and “significant improvements and cost savings.” Although we agree that CMS’s focus on quality and costs has been meaningful to hospitals and patients nationwide, we believe a more nuanced assessment of the programs’ effects is warranted. (Source: JAMA)
Source: JAMA - September 22, 2020 Category: General Medicine Source Type: research

Physicians and Social Determinants of Health —Reply
In Reply We are heartened to see that all 3 letters agree in various ways with the principle expressed in our Viewpoint that the social determinants of health should not be overmedicalized and that the drivers of poor health largely sit outside the health care system, rooted in societal structures, power, and money. (Source: JAMA)
Source: JAMA - September 22, 2020 Category: General Medicine Source Type: research

Novel Device Improves Barrett Esophagus Diagnosis in Primary Care
Testing with a spongy device that ’s swallowed to collect esophageal cells and retrieved via a thread attached to it improved general practitioners’ detection of Barrett esophagus among patients with gastroesophageal reflux, according to a trial in The Lancet. (Source: JAMA)
Source: JAMA - September 22, 2020 Category: General Medicine Source Type: research

Baloxavir Protects Against Household Influenza Spread
Baloxavir marboxil, a polymerase acidic protein endonuclease inhibitor, prevented influenza from spreading in households with a confirmed case, a trial in The New England Journal of Medicine reported. Baloxavir is approved as treatment for uncomplicated influenza A and B and for patients at risk for complications. (Source: JAMA)
Source: JAMA - September 22, 2020 Category: General Medicine Source Type: research

Shared Decision-making Doesn ’t Change Anticoagulation Treatment
Physician satisfaction and patient engagement improved when they used a shared decision-making (SDM) tool for anticoagulant treatment. But their treatment decisions didn ’t differ from patients receiving standard care, a trial in JAMA Internal Medicine reported. (Source: JAMA)
Source: JAMA - September 22, 2020 Category: General Medicine Source Type: research

Intravenous Ibuprofen Caldolor Reduces Opioids After Orthopedic Trauma
Intravenous (IV) ibuprofen adequately relieved acute pain and minimized opioid use in the first 48 hours after an orthopedic trauma, a trial in the Journal of Orthopaedic Trauma reported. (Source: JAMA)
Source: JAMA - September 22, 2020 Category: General Medicine Source Type: research

Mixed Results for Progesterone for Miscarriage Prevention
Progesterone therapy in the first trimester of pregnancy did not result in a greater rate of live births among women with a high risk of miscarriage, according to a trial in Health Technology Assessment. Women with previous miscarriages, however, benefited from progesterone therapy. (Source: JAMA)
Source: JAMA - September 22, 2020 Category: General Medicine Source Type: research

Negative Pressure Wound Therapy vs Standard Dressing and Infection in Obese Women After Cesarean Delivery
This open-label randomized trial compares the effects of preventive negative pressure wound therapy vs standard wound dressing on surgical site infection among obese women after cesarean delivery. (Source: JAMA)
Source: JAMA - September 22, 2020 Category: General Medicine Source Type: research

Patient Information: High Blood Pressure
This JAMA Patient Page explains what high blood pressure is, why it is important to control, the difference between the top (systolic) and bottom (diastolic) numbers, and how it is best treated and prevented. (Source: JAMA)
Source: JAMA - September 22, 2020 Category: General Medicine Source Type: research

The Exact Shade of Code Grey —Sutter Psych Hospital
What anomalous culture were we, the thinning pebbles under a river, or amethyst-black pearls? The shade of code meant women, a girls ’ fight on cold stone cement, or stainless steel sink, silver slicked with shad scales, surfaces we shrank from so that hearing it PA’d we’d back into shared rooms we’re territorially squeezed to get along in, like manx-gray cats in factory-ratty industrial grass. Let the women brawl, the ni cotine-patched princesses, the breast-biters, and try to fuzz over the trauma with pewter lavender of a Weimaraner— coat and eyes paler and more plaintive than Code Black, wa...
Source: JAMA - September 22, 2020 Category: General Medicine Source Type: research

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(Source: JAMA)
Source: JAMA - September 22, 2020 Category: General Medicine Source Type: research

Neurology and COVID-19
In this Viewpoint, JAMA Neurology editors review the journal ’s more important articles advancing scientific understanding of COVID-19 in the first 6 months of the pandemic, including surveys of neurologic manifestations of the infection and identification of potential direct viral involvement in the central nervous system. (Source: JAMA)
Source: JAMA - September 22, 2020 Category: General Medicine Source Type: research

Psychiatry and COVID-19
In this Viewpoint, JAMA Network ’s psychiatry editors review how the coronavirus disease 2019 (COVID-19) pandemic has affected the practice of psychiatry in its first 6 months, for example, through disruptions of care provided in group settings, provision of telehealth, and widespread anxiety and health care worker burnout and d epression. (Source: JAMA)
Source: JAMA - September 22, 2020 Category: General Medicine Source Type: research

Pediatrics and COVID-19
In this Viewpoint, the editor of JAMA Pediatrics summarizes the effect on children of the first 6 months of the COVID-19 pandemic, reviewing evidence for why they seem not to become ill or as sick as adults and discussing the pandemic ’s likely long-term effects on child development and psychological health. (Source: JAMA)
Source: JAMA - September 22, 2020 Category: General Medicine Source Type: research

Cardiology and COVID-19
In this Viewpoint, JAMA Cardiology editors review the journal's more inportant articles advancing the scientific understanding of COVID-19 and the heart in the first 6 months of the pandemic, including evidence of direct myocardial injury and indirect effects of the pandemic on outcomes for patients with CVD postponing care for fear of contracting the virus. (Source: JAMA)
Source: JAMA - September 22, 2020 Category: General Medicine Source Type: research

Internal Medicine and COVID-19
In this Viewpoint, JAMA Internal Medicine editors offer a broad review of the clinical science emerging from the first 6 months of the coronavirus disease 2019 (COVID-19) pandemic, including epidemiology of the infection, evidence that has influenced clinical care, and a discussion of workforce and supply chain issues and health inequities affecting patients and essential workers. (Source: JAMA)
Source: JAMA - September 22, 2020 Category: General Medicine Source Type: research

Surgery and COVID-19
In this Viewpoint JAMA Surgery ’s editor reviews how the COVID-19 pandemic has affected the practice of general surgery in its first 6 months, including the need for universal precautions to mitigate the risks of infection transmission, the cessation and resumption of elective procedures, and adverse effects on educational expe riences of students aspiring to the specialty. (Source: JAMA)
Source: JAMA - September 22, 2020 Category: General Medicine Source Type: research

JAMA Network Open and COVID-19
In this Viewpoint, JAMA Network Open editors review the journal's more important articles advancing scientific understanding of COVID-19 in the first 6 months of the pandemic, and discuss the importance of a global open access journal to meeting the public health challenge. (Source: JAMA)
Source: JAMA - September 22, 2020 Category: General Medicine Source Type: research

Dermatology and COVID-19
In this Viewpoint, JAMA Dermatology editors review the skin findings seen in association with coronavirus disease 2019 (COVID-19), how best to respond to those manifestations, and ways the pandemic has affected the practice of dermatology, including reassignment of specialists to COVID-19 care and the transition to teledermatology. (Source: JAMA)
Source: JAMA - September 22, 2020 Category: General Medicine Source Type: research

Otolaryngology and COVID-19
In this Viewpoint, JAMA Otolaryngology –Head& Neck Surgery ’s editor in chief reviews how the COVID-19 pandemic has affected the practice of otolaryngology–head and neck surgery in its first 6 months, including through a shift away from procedural management of head and neck disease toward medical and noninvasive management to mitigate risk of infection transmission, and through the acute rise in incidence of patients with olfactory dysunction requiring consultation and follow-up. (Source: JAMA)
Source: JAMA - September 22, 2020 Category: General Medicine Source Type: research

Nephrology and COVID-19
In this Viewpoint, JAMA ’s nephrology associate editor and colleagues review how COVID-19 has affected the practice of nephrology, including the rise in incidence of acute kidney injury (AKI) in patients with more severe disease, shortages of supplies and staff to care for AKI patients, effects on kidney transplantation, and implementation of telehealth. (Source: JAMA)
Source: JAMA - September 22, 2020 Category: General Medicine Source Type: research

Oncology and COVID-19
This Viewpoint summarizes the clinical characteristics of patients with cancer as associated with increased mortality risk from COVID-19, and it highlights important areas where more research is needed. (Source: JAMA)
Source: JAMA - September 22, 2020 Category: General Medicine Source Type: research

Ophthalmology and COVID-19
In this Viewpoint, JAMA Ophthalmology ’s editor reviews the known eye manifestations of COVID-19, the potential for ocular transmission of illness, and the effects of the pandemic on ophthalmologic practice and research. (Source: JAMA)
Source: JAMA - September 22, 2020 Category: General Medicine Source Type: research

Health Policy and COVID-19
In this Viewpoint, JAMA Health Forum ’s editor reviews important policy issues that characterized the first 6 months of the COVID-19 pandemic, including personal protective equipment (PPE) shortages, health inequities among vulnerable populations, requests from patients for medical exemptions from face mask requirements, and the bene fits and risks of school reopenings. (Source: JAMA)
Source: JAMA - September 22, 2020 Category: General Medicine Source Type: research

Hand Sanitizer Poisoning and Deaths Reported in 2 States
Fifteen people were hospitalized in Arizona and New Mexico after they drank hand sanitizer containing methanol. Four of the patients died and 3 experienced vision loss, according to a report from CDC investigators and state public health officials. (Source: JAMA)
Source: JAMA - September 22, 2020 Category: General Medicine Source Type: research

Pandemic ’s Mental Health Toll Grows
Considerable increases in mental health disorders since coronavirus disease 2019 (COVID-19) emerged demonstrate the need for specific screening tools to detect pandemic-related trauma and stress, according to a recent study. (Source: JAMA)
Source: JAMA - September 22, 2020 Category: General Medicine Source Type: research

Association of Nursing Home Ratings and COVID-19 Cases
This study evaluates COVID-19 case rates between high- and low-performing nursing homes based on CMS quality measures. (Source: JAMA)
Source: JAMA - September 15, 2020 Category: General Medicine Source Type: research

Point Prevalence of SARS-CoV-2 Infection Among Residents of Connecticut Nursing Homes
This study describes the point prevalence of polymerase chain reaction tests positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among residents of a sample of Connecticut nursing homes in the first half of May 2020. (Source: JAMA)
Source: JAMA - September 15, 2020 Category: General Medicine Source Type: research

Incorrect Axis Alignment in Figure
This article was corrected online. (Source: JAMA)
Source: JAMA - September 15, 2020 Category: General Medicine Source Type: research

Challenging the “Scoop and Run” Model for Management of Out-of-Hospital Cardiac Arrest
Adult out-of-hospital cardiac arrest (OHCA) represents an enormous public health challenge in the US, with an estimated incidence of 140.7 per 100  000 persons per year. Of the 347 322 cases of OHCA assessed by emergency medical services (EMS) in 2015, 52% underwent resuscitation efforts with 10.4% of these surviving to hospital discharge. There is, however, significant regional variation in the incidence of, mortality due to, and survival to discharge associated with OHCA. Historically, management of OHCA in the US was guided by the model of rapidly transporting the patient to a hospital, in contrast to the model used...
Source: JAMA - September 15, 2020 Category: General Medicine Source Type: research

Phasing Out Potentially Hazardous Food Packaging
Three manufacturers agreed to a 3-year phaseout of certain perfluoroalkyl and polyfluoroalkyl substances (PFAS) that are used to prevent grease from penetrating food packaging such as fast-food wrappers and takeout boxes, the FDA announced. (Source: JAMA)
Source: JAMA - September 15, 2020 Category: General Medicine Source Type: research

CBD Drug Is Approved for a Third Form of Epilepsy
A drug containing the marijuana derivative cannabidiol (CBD) was approved to treat seizures associated with tuberous sclerosis complex (TSC) in patients aged 1 year or older. TSC is a genetic disease that causes benign tumors to grow throughout the body. It affects 1 in 6000 people. (Source: JAMA)
Source: JAMA - September 15, 2020 Category: General Medicine Source Type: research

Oral Drug Approved for Spinal Muscular Atrophy
The first oral therapy for adults and children aged 2 months or older who have spinal muscular atrophy (SMA) has received FDA approval. (Source: JAMA)
Source: JAMA - September 15, 2020 Category: General Medicine Source Type: research

Estimating Risk Ratios and Risk Differences
This JAMA Guide to Statistics and Methods explains the differences between risk ratios and odds ratios and when each is the more appropriate statistic to estimate measures of effect or association in research findings. (Source: JAMA)
Source: JAMA - September 15, 2020 Category: General Medicine Source Type: research

Audio Highlights
Listen to the JAMA Editor ’s Audio Summary for an overview and discussion of the important articles appearing in this week’s issue of JAMA. (Source: JAMA)
Source: JAMA - September 15, 2020 Category: General Medicine Source Type: research

New Rules for the Pandemic Era
Coronavirus disease 2019 (COVID-19) is not the world ’s first pandemic, and it is unlikely to be the last. In recent years, there have been actual or potential pandemics in 2002 (severe acute respiratory syndrome coronavirus), 2009 (H1N1 influenza), 2012 (Middle East respiratory syndrome coronavirus), and 2014 (Ebola). The new normal seems to be an actual or potential epidemic every 2 to 3 years. (Source: JAMA)
Source: JAMA - September 15, 2020 Category: General Medicine Source Type: research